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Do You Know Where People Aren’t Dying from Substance Use Disorders and Mental Health Concerns?

Do You Know Where People Aren’t Dying from Substance Use Disorders and Mental Health Concerns?

Last year we had over 60,000 deaths from opioids. We had over 100,000 deaths from alcohol and alcohol related illnesses. Of the roughly 40,000 gun deaths we had in 2017, approximately 25,000 of them were self-inflicted mental health related suicides.

Of the approximately 15,000 remaining gun homicides, the overwhelming majority fall into either gang violence over control of local drug trades or untreated mental health concerns, leaving individuals with an inability to emotionally regulate and a propensity for violence. The 25,000 gun related suicides account for approximately 50% of the roughly 50,000 suicides we experienced as a nation in 2017.

There were an additional 40,000 vehicular deaths in 2017—a large, but under-reported percentage of which are the direct result to substance use disorders and mental health concerns. Last year also saw 480,000 deaths from tobacco related illnesses. Wildly difficult to pin down numbers, such as eating disorder related deaths, often don’t even get calculated because they’re under 20,000 annually, but each individual one of those deaths are just as devastating to the families left behind.

Many of these numbers are actually higher due to the staggering number of misreported deaths, but those are the conservative figures. We’re losing somewhere in the neighborhood of three quarters of a million people to substance use disorders and mental health concerns each year now. However, you want to slice it, we lost the entire population of Seattle in 2017, and we’ll lose the entire population of Los Angeles over the next 5 years.

2018 is going to be even worse.

There is one place, however, where our fellow citizens with mental health concerns and substance use disorders virtually never experience death. That place is treatment, that place was treatment 50 years ago, and that place will be treatment 50 years from now.

Sick brains require healthy supportive environments to heal in the same way sick bodies require healthy supportive environments in which to heal. This isn’t an argument for the Life of Purpose’s academically focused model for older adolescents and emerging adults specifically—this is an argument for treatment in general.

Do you know how many kids die while engaged in wilderness treatment? Do you know how many people die while receiving residential treatment or residential medical detox? Do you know how many people die while undergoing eating disorder treatment? Get your hands out because the numbers are staggeringly low and don’t have commas in them. You can count them on your fingers.

Even at the subacute levels of care in which individuals have tremendous freedom and autonomy, the likelihood of death is hundreds of times lower than it is for their peers with comparably severe substance use disorders and/or mental health concerns. This, of course, doesn’t require a statistician to figure out. Any human being with a shred of common sense knows this fact.

Obviously, an individual in in early recovery is going to do better seeing a clinician in private practice than if they don’t see one. The individual in a structured supportive recovery residence is going to do better than the individual in an apartment. The family working with an education consultant or interventionist is going to do better than if they don’t have those supports in place.

Most importantly though, an individual with a substance use disorder not taking drugs is much, much, much less likely to die from his or her substance use disorder than while actively using life threatening substances and engaging in life threatening behaviors multiple times per day.

We are now five years into a financially driven major push to divert individuals with substance use disorders and/or mental health concerns away from receiving treatment. So aggressive is this push that every individual who has ever received treatment and subsequently has a fatal re-occurrence of use, is held up as an example of how treatment doesn’t work.

I would point out that the opposite condition is never, ever, under any conditions mentioned in our media or our medical literature. We do not discuss the now hundreds of thousands of individuals who were told that treatment doesn’t work and ended up in a body bag. We do not discuss how many fatal overdoses occurred in individuals whose family was given an “alternative to treatment” by a medical professional. We do not discuss the fact that we started this push when we had 10,000 opioid deaths per year and all we have successfully managed to do on a macro scale is push up market demand for fentanyl-laced heroin to break diverted and abused medication assisted treatment barriers in actively using individuals’ brains.

On opioids alone, we’ve gone from 10,000 deaths per year to over 60,000 deaths per year in a 5-year span. Obviously opioid users didn’t get six times as accident prone in that span of time. Equally obvious, is that we didn’t get a functional solution to our societal problem, as any hospital in America could easily determine simply by drug testing fatal and non-fatal overdoses for the diverted and abused MAT drugs that the, now, majority of individuals in the grips of an opioid use disorder use in conjunction with heroin.

Every police officer could tell you the same thing, as literally every heroin dealer they now bust also now deals in black market diverted MAT drugs, the way they all dealt in black market diverted pain medications a decade ago. We could, of course, immediately eliminate this portion of the problem by simply shifting to the long acting, non-divertible, injectable MAT drugs that already exist, but at the end of the day the one, and only, thing that is going to start seriously putting a dent in our death toll is expanding access to treatment.

Substance use disorders and mental health concerns are to 2018 America what chronic kidney disease was to 1972 America. They are a boogeyman lurking on the fringe of every family that if left untreated causes suffering and death. If we, as a society, were able to come together and determine that nobody should die because they and/or their families couldn’t cover the cost of kidney care nearly half a century ago, we should be able to provide the same protections for American families dealing with a much more complex organ—the human brain.

Expanding access to treatment is the morally right thing to do, it’s the fiscally cheaper thing to do, and most importantly it’s the only thing that will actually work because it’s the only thing that does actually work on a large scale. Treatment is, has been, and will continue to be the safest place for our most at risk population to start another chance at life.

 

Andrew Burki outcome based reimbursement

Andrew Burki, MSW

CEO, Life of Purpose

aburki@lifeofpurposetreatment.com

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